Peer-reviewed article
Exploring infant safe sleep practices and sleep arrangement motivations in a South African sample.
Jacomien Muller ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined infant sleep practices and the reasons South African caregivers choose different sleep arrangements for their babies. Researchers surveyed 201 caregivers and found that bed-sharing and non-supine sleeping were common, with unemployed caregivers being twice as likely to not follow safe sleep guidelines. Caregivers' motivations for sleep arrangements included feeding, bonding, safety, and their own sleep quality. The findings suggest that safe sleep interventions need to account for caregivers' practical circumstances and socioeconomic situations.
Key points
- Bed-sharing and non-supine sleeping were common practices among South African caregivers
- Unemployed caregivers were more than twice as likely to fall into the low-adherence group (45.9% vs. 20.5%)
- Caregiver characteristics explained significant variance in adherence beyond child characteristics (ΔR2 = 0.20, p = .022)
- Primary motivations for bed and room-sharing were feeding, bonding, and safety
- Separate-room sleeping motivations centered on caregiver sleep quality
Limitations
This was a cross-sectional online survey, so it cannot establish causality or account for selection bias among caregivers with internet access. The study does not provide information about the actual incidence of sudden unexpected infant death among different adherence groups.
Abstract
Sudden unexpected infant death remains a significant public health concern, with South Africa reporting among the highest incidence globally. However, little is known about infant sleep practices, motivations for sleep arrangements, or adherence to safe sleep recommendations within this context. This study explored caregiver and child characteristics associated with potential sleep-related risk, and caregiver motivations underlying infant sleep arrangements, among South African caregivers. A cross-sectional online survey was completed by 201 caregivers of infants. Prevalence of adherence to American Academy of Pediatrics guidelines was determined. A safe sleep composite score, derived from items of the Brief Infant Sleep Questionnaire-Revised, classified caregivers into low-, moderate-, and high-adherence groups. Bivariate associations between demographic characteristics and low-adherence group membership were examined using chi-square tests, with hierarchical multiple regression to identify predictors of adherence to guidelines. Prevalence of motivations for sleep arrangements were determined and compared across demographic characteristics. Bed-sharing and non-supine sleeping was common. Unemployed caregivers were more than twice as likely to fall into the low-adherence group (45.9% vs. 20.5%), and caregiver characteristics explained significant variance beyond child characteristics (ΔR2 = 0.20, p = .022), with unemployment the only significant independent predictor. No child characteristics were associated with adherence. Feeding, bonding, and safety were the primary motivations for bed and room-sharing, while separate-room sleeping motivations centered on caregiver sleep quality. Adherence to guidelines is complex. Caregiver characteristics were associated with potential sleep-related risk. Findings support safe sleep interventions tailored to caregivers' practical and socioeconomic circumstances, particularly for unemployed and single caregivers.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Understanding caregiver motivations and characteristics associated with safe sleep practices to inform tailored interventions
- Population
- 201 South African caregivers of infants
Key finding
Unemployed caregivers were more than twice as likely to fall into the low-adherence group (45.9% vs. 20.5%)
Muller · PubMed (US National Library of Medicine) · 13 Oct 2026